How does it work?
Dostinex tablets contain the active ingredient cabergoline, which is a type of medicine called a dopamine agonist. (NB. Cabergoline is also available without a brand name, ie as the generic medicine.) Cabergoline works by mimicking the activity of a substance in the brain called dopamine.
Cabergoline is mainly used to treat disorders that result from high levels of the hormone prolactin in the blood. Prolactin is produced by the pituitary gland in the brain. It is the hormone that stimulates the production of breast milk.
Cabergoline decreases the production of prolactin from the pituitary gland by acting on dopamine receptors found on the pituitary gland.
A high prolactin level is associated with several conditions. Over-production of this hormone can cause abnormal production of breast milk in both men and women (galactorrhoea). It can also cause womens' menstrual periods to become irregular or stop altogether, and can stop ovulation, resulting in infertility. Reducing prolactin levels with cabergoline can therefore treat these conditions - stopping breast milk production and restoring fertility.
Cabergoline is also sometimes used to prevent or stop milk production for medical reasons following childbirth, stillbirth or abortion.
A further use of cabergoline is to reduce prolactin production from a type of tumour of the pituitary gland, called a prolactinoma.
What is it used for?
- Preventing or stopping milk production (lactation) for medical reasons following childbirth, stillbirth or abortion.
- Disorders caused by over-production of the hormone prolactin, such as irregular or missing menstrual periods, stopping of ovulation resulting in infertility, or abnormal production of breast milk in men or women (galactorrhoea).
- Benign tumours in the pituitary gland that cause increased production of the hormone prolactin (prolactinomas).
(NB. Cabergoline is also used in higher doses to treat Parkinson's disease. The Dostinex brand of cabergoline is not licensed for this use. See the Cabaser factsheet linked at the end of this article for more information on this other use of cabergoline.)
- Dostinex tablets should be taken with or after food to minimise the chance of experiencing side effects such as nausea or indigestion.
- This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass. Drinking alcohol may increase the chance of feeling dizzy. It is recommended that your blood pressure is monitored for the first few days if you are taking this medicine following childbirth.
- This medicine can cause sleepiness and on rare occasions people have experienced a sudden onset of sleep during their daily activities. In some cases this occured without any warning signs. Although this is uncommon, you should exercise caution when driving or performing other potentially hazardous activities. People who have experienced sleepiness or an episode of sudden onset of sleep while taking this medicine should not drive or operate machinary. Caution should be observed when drinking alcohol or taking other medicines that cause drowsiness, as this may increase the risk of drowsiness.
- On rare occasions people taking cabergoline have developed a fibrous thickening of the lining that covers some of the internal organs including the heart or the lungs. This is called a fibrotic reaction. Your doctor may want you to have a chest X-ray, echocardiogram and blood tests before starting treatment and regularly during treatment to monitor for this. Consult your doctor if you develop any of the following symptoms while taking this medicine, so they can be investigated: shortness of breath, persistent cough, chest pain, swelling of the lower legs, pain in the lower back, or abdominal pain or tenderness.
- Pathological gambling, increased sex drive and hypersexuality have been reported in people taking dopamine agonists such as this one for Parkinson's disease. If you think this medicine is affecting you in this way, you should consult your doctor.
- It is recommended that women taking this medicine for long periods of time should have regular gynaecological exams, including pregnancy tests and smear tests.
- Dostinex tablets absorb moisture, so you should always replace the cap after taking your tablets. Do not remove the special dessicant granules from the cap, and do not transfer your tablets to another container.
Use with caution in
- Decreased kidney function.
- Disease involving the heart and blood vessels (cardiovascular disease).
- Narrowing of the blood vessels in the hands, causing numb and painful fingers (Raynaud's disease).
- Low blood pressure (hypotension).
- Women with high blood pressure following childbirth.
- Peptic ulcer.
- People with bleeding in the stomach or intestines.
- History of fibrotic disorders affecting the lungs, heart or abdomen.
- History of serious mental illness, particularly psychosis.
- Hereditary blood disorders called porphyrias.
Not to be used in
- Children and adolescents under 16 years of age.
- Allergy to other ergot alkaloid derived medicines, eg pergolide, bromocriptine, lisuride, ergotamine, ergometrine.
- Decreased liver function.
- Women with high blood pressure, tissue swelling (eg swollen ankles, face or hands) and protein in the urine during pregnancy (pre-eclampsia).
- History of depression or psychosis following childbirth.
- Long-term treatment in people who have scar tissue (fibrotic reactions) affecting their heart.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used during pregnancy because its safety has not been fully established. You should use a non-hormonal method of contraception (a barrier method, eg condoms) to prevent pregnancy all the time you are taking this medicine. If you do get pregnant during treatment you should stop taking this medicine and consult your doctor. If you want to try for a baby you should wait for one month after you have stopped taking this medicine. (Ovulatory cycles have been shown to continue for six months after you stop taking the medicine.) Seek further medical advice from your doctor.
- This medicine should not be used by mothers who wish to breastfeed because it suppresses the production of breast milk. If you are taking this medicine to suppress milk production and it doesn't work, you should still not breastfeed, because it is not known if the medicine passes into breast milk. Seek further medical advice from your doctor.
- Take this medication with or after food.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Very common (affect more than 1 in 10 people)
- Heart valve disorders, such as inflammation (pericarditis) or leaking of fluid into the sac surrounding the heart (pericardial effusion). Early symptoms of this may include difficulty breathing, shortness of breath, pounding heart, feeling faint, chest pain, back pain, pelvic pain or swollen legs. As these may be the first signs of a condition called fibrosis, which can affect the lungs, heart/heart valves or abdomen, you should let your doctor know straight away if you experience any of these symptoms.
Common (affect between 1 in 10 and 1 in 100 people)
- Breast pain.
- Indigestion (dyspepsia).
- Abdominal pain.
- Inflammation of the stomach (gastritis).
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Low blood pressure (hypotension).
- Suddenly falling asleep.
- Skin reactions such as rash or itching.
- Hair loss.
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- Muscle weakness.
- Hot flushes.
- Temporary partial loss of vision.
- Pins and needles sensations.
- Cold hands and feet.
- Leg cramps.
Unknown frequency (reported since the medicine has been on the market)
- Abnormal liver function.
- Fibrotic reactions (scar tissue) affecting your heart, lungs or abdomen (see warning section above). The risk of this increases with higher doses and prolonged treatment.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
This medicine is not recommended for use in combination with other ergot alkaloid derivatives, such as pergolide, bromocriptine, lisuride, ergotamine, dihydroergotamine, methysergide or ergometrine.
There may be an increased risk of a drop in blood pressure that makes you feel dizzy if this medicine is taken in combination with other medicines that can lower blood pressure, for example medicines to treat high blood pressure (antihypertensives). Tell your doctor if you feel dizzy after starting treatment with this medicine, as your doctor may need to adjust the dose of your blood pressure medicine.
This medicine should not normally be taken in combination with the following medicines, as these work by decreasing the activity of dopamine in the brain and so may oppose the effect of cabergoline:
- antipsychotic medicines, eg chlorpromazine, haloperidol
Macrolide-type antibiotics such as erythromycin may possibly increase the concentration of cabergoline in the blood, which may increase the risk of its side effects. However, small amounts of erythromycin applied to the skin can be used safely.
Other medicines containing the same active ingredient
Cabergoline tablets are also available without a brand name, ie as the generic medicine.